Partial and Total Knee Replacements

Realistic Expectations

An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.

More than 80% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon's instructions after surgery to protect your knee replacement and taking care of your general health are important ways you can contribute to the final success of your surgery.

Home Planning

Several modifications can make your home easier to navigate during your recovery.

• Secure handrails along all stairways.
• A stable chair for your early recovery with a firm seat cushion, a firm back, two arms, and a footstool for intermittent leg elevation.
• A raised toilet seat.
• A stable shower bench or chair for bathing.
• Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips.
• A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery.
• Removal of all loose carpets and electrical cords from the areas where you walk in your home.

Protecting Your Knee Replacement

There are many things you can do to protect your knee replacement and extend the life of your knee implant. With normal use and activity, every knee replacement implant begins to wear its plastic spacer. Excessive activity or being over-weight may speed up this normal wear and may cause the knee replacement to loosen and become painful.

• Participate in a regular light exercise program to maintain proper strength and mobility of your new knee.
• Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.

With appropriate activity modification, knee replacements can last for many years.

See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your knee replacement seems to be doing fine.

How Is Your New Knee Different?

Pain-free knee motion is the goal of a total knee replacement, but restoration of full motion is uncommon. The motion of your knee before surgery is most likely the same amount of motion in your artificial knee after surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is often uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around the incision. You also may feel some stiffness, particularly with excessive bending activities.

Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

Potential Complications

The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery. The following are other risks related to knee replacement surgery:

• Infection
• Blood Clots
• Leg-length Inequality
• Dislocation
• Loosening and Implant Wear

Activity After Surgery

Exercise is a critical component of home care, particularly during the first few days and weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort at night and with activity is common for several weeks.

Your activity program should include:

• A graduated walking program to slowly increase your mobility, initially in your home and later outside.
• Resuming other normal household activities, such as sitting, standing, and climbing stairs.

Practice your exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.

Although you will be able to walk on crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.

Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that knee replacement surgery will make in your life.